Manet Community Health Center, Inc.
Organization Active NPI Federally Qualified Health Center (FQHC) · Hull, MA
NPI 1285665018 · NPPES record last updated Mar 3, 2023
Key facts
- NPI
- 1285665018
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- License
- 4801 (MA)
- Legal business name
- MANET COMMUNITY HEALTH CENTER, INC.
- Practice address
- 180 George Washington Blvd
Hull, MA 02045-3069 - Phone
- (781) 925-4550
- Fax
- (781) 925-5052
- NPI assigned
- Jul 6, 2006
- Organization subpart
- No
Authorized official
- Name
- Cynthia Sierra
- Title
- Chief Executive Officer
- Phone
- (617) 404-4101
Owners & managing parties with NPI records 1
-
Neda Hovaizi, D.D.S.
Other NPIs with the same Medicare PAC ID 8
Corporate family (same tax ID) 12
Practitioners 52
-
Tasfia Ahmed, DO, MSC
-
Sarah Jane Benoit, LICSW
-
Lyndsay Lee Bethoney, PMHNP-BC
-
Katy E. Bockstall, M.D.
-
Kelly Burke, NURSE PRACTITIONER
-
Mary P Cahill, CPNP
-
Kiley Callahan, FNP-C
-
Nancy Chung, MSN, FNP-BC
-
Timothy Comeaux, LICSW,LADCI
-
Emily Grace Covert, PA-C
-
Pamela G Gordon, MD
-
Carol Noel Hamilton, FNP
-
Charlette Hines, FNP
-
Katherine Anne Johnson, LICSW
-
Robert Joseph, MD
-
Sarah Kiernan, NP
-
Brian T Kroener, MD, MPH
-
Sarah Krueger, FNP-C
-
Celeste Thi Le, RN, RDN
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MA
Federally qualified health center certification: CCN 221866
- Legal name
- MANET COMMUNITY HEALTH CENTER, INC.
- Doing business as
- MANET COMMUNITY HEALTH CENTER AT HULL
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Mar 16, 2005
- Last certification
- Mar 16, 2005
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Incorporated
- Apr 5, 1978 in MA
- Enrollment address
- 180 George Washington Blvd
Hull, MA 20453069
All disclosed owners & managing parties 15
| Name | Role | Since | Share |
|---|---|---|---|
| Cynthia Sierra |
Corporate Officer |
Jan 1, 2016 | 100% |
| Samantha Chen |
Corporate Director |
Jan 15, 2019 | 75% |
| Lisa J Levine |
W-2 Managing Employee |
Mar 18, 2014 | |
| Neda Hovaizi |
Corporate Director |
Jan 15, 2019 | 75% |
| Lawrence Flanagan |
Corporate Director |
Feb 21, 2017 | 75% |
| Mary Benvenuto |
Corporate Officer |
Jan 21, 2020 | 50% |
| Stephen Keches |
Corporate Director |
Jan 16, 2018 | 75% |
| John D Brothers |
Corporate Director |
Dec 5, 2000 | |
| Joseph M Reardon |
Corporate Director |
May 1, 2007 | |
| Robert Griffin |
Corporate Director |
Jan 24, 2011 | |
| John Galluzzo |
Corporate Director |
Jan 24, 2011 | |
| Lavinia M Roosa |
Operational/Managerial Control |
Mar 5, 2001 | 50% |
| Ivan S Wong |
Corporate Director |
Oct 20, 2009 | |
| Linda a Kelly |
Corporate Director |
May 6, 2006 | |
| Anne Bisson |
Corporate Director |
Nov 15, 2016 | 75% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20101102000926 | MA | Part a Provider - Federally Qualified Health Center (FQHC) | 4486555158 | Practice locations: Hull, MA |
National Provider Directory
- Tax ID family
- Manet Community Health Center Inc
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | 4801 | MA | Yes |
Addresses
Primary practice location
180 George Washington Blvd
Hull, MA 02045-3069
Mailing address
110 W Squantum St
North Quincy, MA 02171-2122
Phone (617) 376-3030
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1300555 | Medicaid | MA |
Other names
- Manet Community Health Center, Inc. at Hull
Other providers in Hull, MA
- Amy Perkins Leonard
- Locke White Dental Associates LLC
- Stephen A Locke
- Judith L Lyden
- Rebecca Macdonald
- Maurice Lussier
- Nancy Anne McCarthy
- Kim McGrath
- Kristen Mercurio
- Laney Morse
All providers in Hull, MA · Federally Qualified Health Center (FQHC) in Massachusetts
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 3, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.